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Medical oncologists' perspectives of the Veterans Affairs National Precision Oncology Program
Vishal Vashistha1,2,3, Pradeep J Poonnen1,2,3, Jane L Snowdon4
1Department of Veterans Affairs, National Precision Oncology Program, Durham, NC, United States of America.
Background:
To support the rising need for testing and to standardize tumor DNA sequencing practices within the U.S. Department of Veterans Affairs (VA)'s Veterans Health Administration (VHA), the National Precision Oncology Program (NPOP) was launched in 2016. We sought to assess oncologists' practices, concerns, and perceptions regarding Next-Generation Sequencing (NGS) and the NPOP.
Materials And Methods:
Using a purposive total sampling approach, oncologists who had previously ordered NGS for at least one tumor sample through the NPOP were invited to participate in semi-structured interviews. Questions assessed the following: expectations for the NPOP, procedural requirements, applicability of testing results, and the summative utility of the NPOP. Interviews were assessed using an open coding approach. Thematic analysis was conducted to evaluate the completed codebook. Themes were defined deductively by reviewing the direct responses to interview questions as well as inductively by identifying emerging patterns of data.
Results:
Of the 105 medical oncologists who were invited to participate, 20 (19%) were interviewed from 19 different VA medical centers in 14 states. Five recurrent themes were observed: (1) Educational Efforts Regarding Tumor DNA Sequencing Should be Undertaken, (2) Pathology Departments Share a Critical Role in Facilitating Test Completion, (3) Tumor DNA Sequencing via NGS Serves as the Most Comprehensive Testing Modality within Precision Oncology, (4) The Availability of the NPOP Has Expanded Options for Select Patients, and (5) The Completion of Tumor DNA Sequencing through the NPOP Could Help Improve Research Efforts within VHA Oncology Practices.
Conclusion:
Medical oncologists believe that the availability of tumor DNA sequencing through the NPOP could potentially lead to an improvement in outcomes for veterans with metastatic solid tumors. Efforts should be directed toward improving oncologists' understanding of sequencing, strengthening collaborative relationships between oncologists and pathologists, and assessing the role of comprehensive NGS panels within the battery of precision tests.
Insights
The National Precision Oncology Program (NPOP) enhances tumor DNA sequencing for veterans. Oncologists see Next-Generation Sequencing (NGS) as vital for improving outcomes and research in precision oncology.
Area of Science:
- Oncology
- Genomics
- Precision Medicine
Background:
- The U.S. Department of Veterans Affairs (VA) launched the National Precision Oncology Program (NPOP) in 2016 to standardize tumor DNA sequencing.
- The program aims to meet the increasing demand for advanced cancer testing within the Veterans Health Administration (VHA).
- This study assesses oncologists' perspectives on Next-Generation Sequencing (NGS) and the NPOP's role in their practice.
Purpose of the Study:
- To evaluate oncologists' current practices, concerns, and perceptions regarding tumor DNA sequencing using NGS.
- To understand oncologists' expectations, procedural experiences, and perceived utility of the NPOP.
- To identify areas for improvement in the implementation and utilization of precision oncology services within the VHA.
Main Methods:
- Semi-structured interviews were conducted with 20 medical oncologists who had ordered NGS tests through the NPOP.
- A purposive total sampling approach ensured representation from oncologists experienced with the NPOP.
- Thematic analysis, combining deductive and inductive coding, was used to analyze interview data.
Main Results:
- Five key themes emerged: the need for enhanced education on tumor DNA sequencing, the critical role of pathology departments, NGS as a comprehensive precision oncology tool, NPOP's expansion of options for select patients, and NPOP's potential to improve VHA oncology research.
- Participating oncologists highlighted the importance of pathology support in test completion.
- Next-Generation Sequencing (NGS) was recognized as the most comprehensive testing modality for precision oncology.
Conclusions:
- Medical oncologists believe NPOP-facilitated tumor DNA sequencing can improve outcomes for veterans with metastatic solid tumors.
- Key areas for advancement include improving oncologists' understanding of sequencing, fostering collaboration between oncologists and pathologists, and evaluating comprehensive NGS panels.
- The findings suggest a need for continued development and support of precision oncology initiatives within the VHA.
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